Nordic Walking for back pain rehabilitation

photo heather watsonThanks to NWUK Instructor and physiotherapist Heather Watson (pictured) for sharing this excellent, comprehensive case study of how Nordic walking was used to rehabilitate a 48 year Woman who suffered from back and leg pain. First presented at our National Conference in 2011, this study is a useful resource for all those involved in rehabilitation exercise.

We have outlined the key points of the case study below and attached the full paper as a PDF (see below).

The patient presented with the following medical history: chronic low back and leg pain on the left side which was recently aggravated by a fall from her horse. Clinical findings on examination included:

  • Limited lumbar movements
  • Occasional left foot pins and needles and numbness
  • Normal reflexes
  • Painful resisted muscle tests with left leg
  • Rounded trunk posture when standing
  • Poor weight bearing on left leg
  • Reduced arm swing on the left
  • Reduced body rotation when walking

Compensation on the right side of the body with right arm and trunk pulling down when walking caused by overactivity of the latissimus dorsi muscles.

The treatment given to the patient previously in the clinic included manual therapy, soft tissue release, and a remedial exercise programme based on the JEMS Movement approach (Elphintson 2008). Nordic Walking was introduced after an initial activity focusing on foot movements, posture and weight bearing to help activate the stabilisers and prepare for walking. The Nordic Walking poles helped the patient to equalise weight bearing, enabling achievement of a more balanced posture by allowing the left side of her body and her left leg to take more weight, thereby releasing some of the compensation from the right side. A relative lack of trunk stability had resulted in compensatory stabilising strategies on the right side with the latissimus dorsi becoming overactive in response to a weak gluteus maximus muscle on the left (Elphinston 2008), therefore restoration of trunk stability was an initial priority to prevent this issue from recurring. Single poling, with a pole in the left hand only, was used for part of the session to increase the patient’s awareness of her left arm and trunk, and to enable the right arm to start relaxing. Once increased activation of the stabilisers had been achieved with better posture and improved weight bearing, allowing improved stride length and hip motion, better activity in the gluteus maximus, a reduction of over activity in the right latissimus dorsi was possible. This enabled the right arm to release and swing more freely which was necessary prior to working on body rotation.

Loss of counter body rotation results in loss of elastic energy created by the myofascial sling (Figure 2) since it is thought that the sling acts like an elastic band – when the body rotates energy is stored as it contracts and released when it relaxes, helping propel the body forward and allowing the transfer of forces across the body and through the limbs.

Improved body rotation, where the arms are allowed to swing freely, results in a larger range of motion with the elasticity creating momentum. Rotation increases the tension through the myofascial sling which can help to stimulate activation of the gluteal muscles on opposite sides of the body (Elphinston 2008, 2013). In turn, they are then able to generate more power for the propulsion required for walking, resulting in a lengthened stride with improved hip motion. The movement inherent in rotation reduces tension in the spinal muscles that can be a contributing factor in pain and discomfort. In the patient’s case, she had been walking slowly due to back and leg pain, which in turn reduced her arm swing, and consequently her body’s counter-rotation. With the pain having already compromised efficiency in her gluteal muscles, and trunk and pelvic stabilisers, this lack of rotation further reduced her ability to access these muscles and walk more effectively.

The patient was able to practice and improve her arm swing technique using Nordic Walking poles to give extra momentum to the swing.

This case considers the interventions made in a single 1 hour session with the patient which enabled her to achieve an improved posture when walking along with improved dynamic control of the trunk. On observation her weight bearing appeared to became more symmetrical and she had better acceptance of weight through the left leg, and increased awareness of her left arm and leg. Body rotation was also improved with the consequent immediate results of increased walking speed and fluidity of movement.

Conclusion
In this case study Nordic walking enabled the therapist to progress rehabilitation into functional outdoor walking using the principles of Nordic walking technique applied with a professional understanding of the underlying condition, and drawing on techniques to improve movement efficiency and fluency.

Nordic walking, delivered by an appropriately qualified instructor who is also a physiotherapist can be a useful adjunct to standard physical rehabilitation for progressing function outside of the clinic, and can support a patient to take up regular independent walking exercise by increasing confidence that it is safe and effective.

In summary, Nordic Walking is an accessible exercise technique which may help to reduce back pain and tension, enabling the individual to move more freely and feel the benefits of regular physical activity. As the individual progresses, stamina and fitness is likely to increase, which may help reduce the risk of longer term health problems and the risk of recurrent or persistent back pain and health issues associated with an inactive lifestyle.

Tips for Nordic Walking Instructors working with people with existing back and/ or leg pain:

  • Aim to achieve some improvement in walking posture in the first session as this will increase activation of the deep trunk stabilisers and help establish equal weight bearing.
  • Any side-to-side trunk movement observed is likely to be associated with loss of body rotation and/ or poor use of one arm.
  • Practice arm swings while walking, and if necessary standing still, to regain the feeling of rotation and progress into body rotation while walking.
  • Avoid steep or long hills in the early stages until a good basic technique has been established as these can aggravate pain if there is insufficient muscle power for effective propulsion.

Note:
The case study described here is based on a case presented at the Nordic Walking UK Instructor Conference 2011 by Heather Watson, a Chartered Physiotherapist with a special interest in movement and exercise. Heather is a qualified Nordic Walking Instructor and combines her knowledge and expertise as a Specialist Musculoskeletal Physiotherapist, and her educational experience as a national Tutor for the Joanne Elphinston Movement Systems (JEMS) with her skills as a Nordic Walking Instructor.

Nordic Walking technique instruction should only be conducted under the guidance of a fully qualified Nordic Walking Instructor: For more information about Nordic walking and to find a qualified instructor please visit www.nordicwalking.co.uk . For clients with significant health issues Nordic walking Instructors should also hold an Exercise Referral qualification or be a qualified health professional. See HERE for details.

NWUK FREEDOM card is launched!

 

The Nordic Walking UK FREEDOM card

The Nordic Walking UK Freedom card was launched in Spring 2013. This card is issued by NWUK delivery partner Instructors who have completed additional training to be able to deliver our bespoke programmes.

The NWUK ‘Learn to Nordic Walk’ programme consists of a simple teaching method developed by our experts which empowers the Nordic Walker to understand how to match the technique to their own personal goals.Taught over 4 sessions, it ensures that every person who completes the course can Nordic Walk at an intensity that is safe for them and is guranteed to get them the results they want.

Back of the NWUK FREEDOM card

At this point, the Instructor issues the FREEDOM card which provides benefits to the card holder (see below) and enables Nordic Walk leaders to be safe in the knowledge that the holder has been taught correctly. The inclusion of the FREE Safety 24 scheme (see below) also protects leaders from the need to carry detailed medical and next of kin information out on walks. FREEDOM cards are accepted by delivery partner Instructors and projects across the UK which opens up access to a vast number of walks for card holders.

Registration of the FREEDOM card also provides the holder with the option of adding their medical history and next of kin onto the secure SAFETY 24 system which is a unique service that provides the Emergency services with all this information in the event of an accident. Safety 24 also liaise with the next of kin and manage the situation for the card holder. Carrying a FREEDOM card will provide this protection day and night whether Nordic Walking or not and this service is usually £7.50.

Other benefits include a £5 gift voucher to be redeemed against Nordic Walking poles or equipment plus other discounts including:-

20% off Warners activity breaks – some even include Nordic Walking!

20% off ski -ing at SNOZONE indoor ski centres – Milton Keynes and Castleford

 

hn_logo_small norway directEnjoy 20% off stunning holidays in Norway with the UKs leading operator of specialist holidays in this stunning nordic location. Activities include Sea Fishing, Dog sledding, Mountain biking, climbing , Golf and of course….nordic walking!

Watch this space for lots of other exciting opportunities that will be coming on board very soon.

Instructors and projects that use the FREEDOM card system can be found on our search page and they will have an icon to show they offer the programmes and the cards.

Holders of the old style competence card can upgrade by calling their Instructors or Nordic Walking UK HQ on 0333 1234 540

Supporting Behaviour change – the latest course developed by our academy

Obesity and ill health are on the rise and our ageing population is growing – the cost to the nation of the drugs and care required to deal with this are astronimical but we CAN help a lot of people to avoid falling into this trap if we simply MAKE EXERCISE APPEALLING!

Simple physical activity sessions can prevent the need for drugs in many cases but how do we encourage those who need it most to join in? It’s not that easy………….often they have an inherrant dislike for sport/activity and their confidence is low – add to that the complications presented by their medical conditions and you get a cocktail of reasons why exercise has never worked for them before

So, how can we make a difference? It’s simple, Nordic Walking can be taken to those who need it most but here’s the important part…. the skill of the instructor is the key to whether or not 80% of the population will actually come to your classes and change their lifestyle for good.

A few simple changes to how you promote yourself and how you speak to and support people can make a world of difference. Now NWUK have developed a unique one day course that will help walking professionals to understand how people feel, what their barriers to change are and most importantly, how you can help them make positive changes.

SUPPORTING BEHAVIOUR CHANGE

One day programme                                                                   Tutor Robin Gargrave

  • Barriers to change
  • Motivation theory
  • Motivational interviewing skills
  • Effective communication skills
  • Supporting behaviour change

The course will be tutored by Robin Gargrave who was a headline speaker at the NWUK Making Walking work conference and has over 25 years experience in delivering effective fitness & wellbeing concepts. A previous Director of programmes for Central YMCA Fitness and keynote fitness Industry expert, Robin will inspire you and change the way you dleiver activity programmes….for good!

The skills gained from this course will ensure you attract more people to your classes and establish yourself as an Instructor (or project )who wants to make a difference to their community. NWUK are committed to developing a network of Instructors who can be relied on to help us get the nation more active and this course will make a world of difference.

Pre requisites:-

The course is open to all qualified Fitness professionals & Nordic Walking Instructors(level 2 minimum)

Location Milton Keynes

Date 21st June 2013

REPS cpd points

Call Kaye on 0845 260 9339 to find out more,

 

Torbay Care Trust launch Nordic Walking

Elaine Mason and Instructor Davinia

Elaine Mason and her team at the Torbay Care Trust have been pleasantly surprised at the response to their Nordic Walking programme and are determined to keep building on that success.

The project is one of many across the UK that have taken advantage of the Nordic Walking UK community package which provides all of the training and support required to ensure a sustainable programme.

The fomula is simple……… NWUK ensures that every project has at least one FULLY QUALIFIED Instructor who receives additional training on how to administrate and market the programme in order to increase participation and ensure sustainability.

The lead Instructor is also trained to CASCADE train their own Nordic walk leaders (who require more in depth training than typical walk leaders due to the intensity levels of nordic walking) These are often volunteers and NWUK feel it is important to protect them fully from the risk of supervising people who may not have a clear understanding of the correct safe levels of intensity. To overcome this, NWUK provide FREEDOM CARDS which are issued by the lead Instructor to signify the participant has been thoroughly screened and has a grasp of how to nordic walk at a level that matches both the current fitness levels (& health issues) and their goals. This is ascertained via the delivery of the bespoke NWUK ‘Learn to Nordic Walk’ course which uses a unique ‘gear system’ and incorporates behavioural change and motivational skills.

The Freedom cards also come complete with the Safety 24 scheme which means projects do not have to ensure that personal data is carried by Leaders in case of accident. In addition, the cards are recognised by other participating groups which means holders can expand their horizons and join in walks across the UK. There are also discounts including a £5 gift voucher towards the purchase of their own poles which has two benefits for the project

1. It ensures their teaching pack of poles is used only during the tuition phase and that regular walkers bring their own poles once they have learned the technique.

2. Many projects also accumulate commission or pass on further discounts via this process

The final benefit of the NWUK Community package is the inclusion in National campaigns managed by NWUK – extra promotion via the NWUK website and finally the use of a marketing tool kit that includes press releases and editable banners, posters and other essential tools for running a full programme.

The NWUK Community package is a set annual fee which includes the use of all additional training, the webpage, marketing tool kit and the issue of unlimited FREEDOM cards worth £7.50 each!

Read more about the Torbay programme here

See all the other successful NWUK community programmes here

 

 

Get into the swing with our daily smovey workout

Smoveys - tone, energise and increase range of movement

Whether you are a regular Nordic walker and very active or somebody who is interested but not yet ventured out with some poles the SMOVEY is the must have exercise tool of 2012. Just 10 – 20 minutes a day will give you NOTICEABLE results.

The Smovey is not simply a weight that you swing as you walk – this clever little device contains steel balls that move when you do and this has THREE amazing effects. First it increases your range of movement and secondly it provides resistance which makes the smovey feel heavier at some points as you swing it – and if that’s not enough….the smovey also VIBRATES with every swing which increases the toning and energising effects. Continue reading

From back pain to a Gallop around Grasmere!

Val and the group complete the Grasmere Challenge with Instructor, John Beetham.

Val Sandham had an extremely painful lower back problem which she describes as so bad that a short walk form her chair to the Kitchen was simply dreadful. Her Osteopath agreed that maybe Nordic Walking could help as it would strengthen the back without any twisting or strain.

He was right, and as Val (pictured here on the left in the cap) had previously attended Core classes with NWUK Instructor John Beetham, she decided to join his Nordic walking sessions in the park even though she was a bit apprehensive about the pain. Continue reading

NWUK NORDIC WELLBEING PROGRAMME

This concept was developed to ensure that those who may struggle to keep up with others on even the most gentle nordic walks can enjoy an outdoor exercise class that combines pole walking with balance, flexibility and vital upper body strength work.

The NWUK wellbeing course – Instructors lesson cards

The course includes joint mobility exercises, relaxation via breathing drills and builds up gradually to improve fitness in a functional way. The strap line is:-

ADDING LIFE TO YOUR YEARS, NOT JUST YEARS TO YOUR LIFE!

 

 

 

Instructors who deliver this concept are trained to combine gentle nordic walking with

NWUK wellbeing balance drills

balance drills, resistance bands, smoveys and EXERSTRIDER strapless walking poles to ensure there are no barriers to taking part and that each participant works according to their own level of mobility and fitness. There is no fear of being left behind, only a friendly exercise class that will overcome any weaker areas and build participants up towards walking more in the future.Great for use with Seniors or those who have been inactive due to poor health but NOT specific exercise referral, this course is ideally placed to help NWUK Instructors to help those who may lack confidence but want to get their bodies moving!

The NWUK Wellbeing programme is being used successfully by community projects and care homes across the UK and can be delivered with minimal equipment & cost.

Instructors who deliver the programme can be identified by the wellbeing icon
on the search page of the NWUK website*Instructors practice balance &
functional exercise

Instructors learn to construct a balanced wellbeing circuit

INSTRUCTOR TRAINING

The training is ONE DAY (from 10 – 4) and a mix of parctical and theory in which they learn how to prepare sessions that cater for the health levels and needs of their clients and to incorporate the elements of fitness into functional exercises that make sense.

They also learn how to utilise EXERSTRIDER strapless poles and understand the difference in technique required.

Exerstrider pole walking technique

 

 

Pre requisites are REPs level 2 Fitness Instructor and NWUK Nordic walking Instructor

COST:- £125 to include drill cards and licence to deliver the branded concept & gain access to the specific marketing materials (annual renewal fee of £69 applies)

NWUK Delivery partners get the training FREE and pay no additional licence fee.

For course dates visit the NWUK Website

* ICON only appears if the Instructor or project chooses to have an enhanced listing on the website.

 

Workplace health scheme – a huge success!

Dedicated DOH staff leave the warmth of Wellington House

Nordic Walking UK recently teamed up with HASSRA (the Dept. of Health’s sport’s and recreation club) to develop a Nordic walking programme for DH staff as part of the Civil Service Physical Activity challenge.

Despite freezing weather and a challenging central London location the project has blossomed into a regular programme for the staff with some impressive results. Continue reading

Conference for walking professionals

Exercise Anywhere Ltd the parent company of Nordic Walking UK are hosting a conference this September for those with an interest in the use of walking programmes as way to provide affordable activity & rehabilitation solutions. Continue reading